Comments on: Implementing an EMR or health IT system is harder than it looks http://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html Tue, 14 Feb 2012 19:56:00 +0000 hourly 1 By: Doc Stonehttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116895 Doc Stone Thu, 05 Nov 2009 00:42:41 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116895 When I ran my own office, my paper charts were available 100% of the time. I have worked in may settings and the probability of charts not being available increased in inverse proportion to the power of the physician to influence the hiring and retention of the person responsible for delivering the chart. Interestingly, the same has held true for the unusability of IT systems. IT does NOT fix poor management . . . rather it magnifies the chaos. A computer is only a calculator that can be instructed to do the same thing over and over again. It is an effort multiplier like a lever. It multiplies misguided efforts as readily as appropriate ones. When I ran my own office, my paper charts were available 100% of the time. I have worked in may settings and the probability of charts not being available increased in inverse proportion to the power of the physician to influence the hiring and retention of the person responsible for delivering the chart. Interestingly, the same has held true for the unusability of IT systems. IT does NOT fix poor management . . . rather it magnifies the chaos. A computer is only a calculator that can be instructed to do the same thing over and over again. It is an effort multiplier like a lever. It multiplies misguided efforts as readily as appropriate ones.

]]> By: Nuclear Firehttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116504 Nuclear Fire Mon, 02 Nov 2009 16:13:45 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116504 @ R Watkins: Ditto @ SpringCharts: my charting/reviewing time per day went up by 2 hours with our EMR. That's 52 hours a month. @ R Watkins: Ditto
@ SpringCharts: my charting/reviewing time per day went up by 2 hours with our EMR. That’s 52 hours a month.

]]> By: R Watkinshttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116501 R Watkins Mon, 02 Nov 2009 15:45:46 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116501 Any office that can't locate 30% of their charts is so poorly run that EMRs won't make any improvement (and may make things worse). Any office that can’t locate 30% of their charts is so poorly run that EMRs won’t make any improvement (and may make things worse).

]]> By: SpringChartshttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116489 SpringCharts Mon, 02 Nov 2009 13:13:01 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116489 On average, 30% of patient charts are not available during a patient visit, according to a Gartner Group research study. With EMRs, patient information is immediately accessible, which can save every doctor using an EMR around an hour per week that would have been spent waiting for charts to be delivered. That's 52 hours a year waiting for charts instead of seeing patients! On average, 30% of patient charts are not available during a patient visit, according to a Gartner Group research study. With EMRs, patient information is immediately accessible, which can save every doctor using an EMR around an hour per week that would have been spent waiting for charts to be delivered. That’s 52 hours a year waiting for charts instead of seeing patients!

]]> By: jsmithhttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116473 jsmith Mon, 02 Nov 2009 01:34:30 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116473 Marianne writes that we all agree that we need a good,simple, effective EHR that will integrate seamlessly with other systems. No, Marianne, everyone does not agree with that. In fact, several of us doctors at this thread have stated that we think EHRs are junk technology that should be scrapped. Moreover, evidence for our view is as strong or stronger as the evidence for your view. I of course don't believe they will be scrapped and fully expect to see collateral damage to the HC system from their implementation. Some technology is fine for the primary care doc. PDAs are great, I use mine all the time, especially epocrates . Our digital radiology setup is fabulous. UpToDate, couldn't live without it. The problem with EHRs is that they force us to deal with irrelevancies and waste our precious time--even the good ones do this, because they turn us into data-entry clerks. Adam Smith addressed this issue in 1776. His example of the pin factory shows how division of labor leads to increased productivity. EHRs go the other direction, lumping physician labor with clerical labor. This leads to decreased productivity. Come on folks, this is a 200 year-old insight, not rocket science. And all the re-engineering in the world won't change this fact. If doctors have to input data and if physician labor is in short supply, then EHRs will decrease productivity. Oh, but they'll improve pt care and save money, they tell us. Balderdash. Show us the data. And that's not all. Med students are not beating down the doors to be EHR-jockeys--I mean primary care docs. Who can blame them? Maybe the hope is that midlevels won't mind. Marianne writes that we all agree that we need a good,simple, effective EHR that will integrate seamlessly with other systems. No, Marianne, everyone does not agree with that. In fact, several of us doctors at this thread have stated that we think EHRs are junk technology that should be scrapped. Moreover, evidence for our view is as strong or stronger as the evidence for your view.
I of course don’t believe they will be scrapped and fully expect to see collateral damage to the HC system from their implementation.
Some technology is fine for the primary care doc. PDAs are great, I use mine all the time, especially epocrates . Our digital radiology setup is fabulous. UpToDate, couldn’t live without it. The problem with EHRs is that they force us to deal with irrelevancies and waste our precious time–even the good ones do this, because they turn us into data-entry clerks. Adam Smith addressed this issue in 1776. His example of the pin factory shows how division of labor leads to increased productivity. EHRs go the other direction, lumping physician labor with clerical labor. This leads to decreased productivity. Come on folks, this is a 200 year-old insight, not rocket science. And all the re-engineering in the world won’t change this fact. If doctors have to input data and if physician labor is in short supply, then EHRs will decrease productivity.
Oh, but they’ll improve pt care and save money, they tell us. Balderdash. Show us the data.
And that’s not all. Med students are not beating down the doors to be EHR-jockeys–I mean primary care docs. Who can blame them? Maybe the hope is that midlevels won’t mind.

]]> By: Doc Stonehttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116464 Doc Stone Sun, 01 Nov 2009 21:07:20 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116464 A great deal of mischief is being caused by the EMR being forced on doctors and hospitals by outside forces. IT is successful when the players who own it, implement it, and control it are free to do so in a manner and at a time of their choosing and initiation because they become convinced that it is going to help them achieve their goals. The health care industry hasn't fully implemented it because they shouldn't. They have only gone as far as they have because they are being coerced. It should be no surprise that under these coercive conditions, it is a failure. Such a process is why the soviet union failed of course.The idea that doctors are luddites is ridiculous. If they were, we would just be getting around to accepting antibiotics for strep throat.The idea that hospitals need to spend massive resources on training to implement a system is ridiculous. If the system is well designed with full knowledge of how the hospital and workers do things, little or no training should be necessary. Good software is intuitive. The best IT system that I have ever used was used by me with no formal training. I was given a user id and password and the rest I picked up on my own or brief 30 second "Let me show you" sessions by other users. It was great.You can't blame inadequate hardware development--that system was in 1987. Every system that I have used since was cumbersome or unusable in comparison. The difference was the software design. Fitting the shoe to the foot rather than the foot to the shoe.Hold harmless clauses make since in most industry software implementations. The industry is completely free to not use software at all, is completely free to set the parameters and desired object and functions if the system. The purchaser is in control and knows it's needs better than the vender and therefore rightfully fully responsible for making sure the product fits those needs. It is the element of coercion that is making the normal "hold harmless" contract seem unfair and it is the force premature implementation that is making the gag clause such a danger, as it prevents working the bugs out of what is a massive beta implementation.The notion that anything any of those clowns in the Senate or congress is actually going to be helpful is, in the face of observed reality, silly. Can anyone actually still believe that our ruling classes can touch anything without turning it into shit? A great deal of mischief is being caused by the EMR being forced on doctors and hospitals by outside forces. IT is successful when the players who own it, implement it, and control it are free to do so in a manner and at a time of their choosing and initiation because they become convinced that it is going to help them achieve their goals. The health care industry hasn’t fully implemented it because they shouldn’t. They have only gone as far as they have because they are being coerced. It should be no surprise that under these coercive conditions, it is a failure. Such a process is why the soviet union failed of course.

The idea that doctors are luddites is ridiculous. If they were, we would just be getting around to accepting antibiotics for strep throat.

The idea that hospitals need to spend massive resources on training to implement a system is ridiculous. If the system is well designed with full knowledge of how the hospital and workers do things, little or no training should be necessary. Good software is intuitive. The best IT system that I have ever used was used by me with no formal training. I was given a user id and password and the rest I picked up on my own or brief 30 second “Let me show you” sessions by other users. It was great.

You can’t blame inadequate hardware development–that system was in 1987. Every system that I have used since was cumbersome or unusable in comparison. The difference was the software design. Fitting the shoe to the foot rather than the foot to the shoe.

Hold harmless clauses make since in most industry software implementations. The industry is completely free to not use software at all, is completely free to set the parameters and desired object and functions if the system. The purchaser is in control and knows it’s needs better than the vender and therefore rightfully fully responsible for making sure the product fits those needs. It is the element of coercion that is making the normal “hold harmless” contract seem unfair and it is the force premature implementation that is making the gag clause such a danger, as it prevents working the bugs out of what is a massive beta implementation.

The notion that anything any of those clowns in the Senate or congress is actually going to be helpful is, in the face of observed reality, silly. Can anyone actually still believe that our ruling classes can touch anything without turning it into shit?

]]> By: JThttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116461 JT Sun, 01 Nov 2009 19:55:34 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116461 Posted on Facebook Posted on Facebook

]]> By: R Watkinshttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116459 R Watkins Sun, 01 Nov 2009 18:49:07 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116459 "I have always found it funny that while medicine is a field of change, we are some of the slowest to want to adopt change, we do so only while complaining and dragging our feet!"I disagree vehemently with this. Medicine is very quick to change when there is valid evidence to prove that the change is beneficial. Most MDs feel instinctively that EMRs will not improve patient care, and so far, the evidence supports their gut reactions. “I have always found it funny that while medicine is a field of change, we are some of the slowest to want to adopt change, we do so only while complaining and dragging our feet!”

I disagree vehemently with this. Medicine is very quick to change when there is valid evidence to prove that the change is beneficial. Most MDs feel instinctively that EMRs will not improve patient care, and so far, the evidence supports their gut reactions.

]]> By: Mariannehttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116451 Marianne Sun, 01 Nov 2009 16:33:08 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116451 As someone who has worked in and around healthcare and the health insurance industry for 30 years I have seen a lot of changes...some good, some bad. I think everyone agrees we need a good, simple, effective EHR system that will integrate seamlessly with other related systems. The problem becomes with getting all the players to work together to create such a system. Every company is worried about profit and securing their section of the market rather than what is in the best interst of the patients, practitioners and payers. The systems has to be something that will work globally to be truly effective. We now have dictation and billing being done off shore to save money, so any system has to work for them. We have surgeries being done remotely via robotic or web instruction so these records have to be able to be accessed globally. We also have the need for other service providers to access and add to the records, such as pharmacies or home health providers so information can be available real time for providers to make the best treatment decisions. With a good system that will serve all those that will interface with it care will improve and after the learning curve, the work load of those using it will decrease. I have always found it funny that while medicine is a field of change, we are some of the slowest to want to adopt change, we do so only while complaining and dragging our feet! I do believe our current EHR options are limited and until we can get cooperation instead of competition between the factions we will not have a strong enough, reliable enough system to see its true capabilities and possibilities. I also believe the best system will probably come about from insiders rather than outsiders trying to get on board with the next great money maker. This will have to happen in the near future, so we as users have to work together to point out the flaws and benefits if we hope to see this technology develop into the useful tool we all need. As someone who has worked in and around healthcare and the health insurance industry for 30 years I have seen a lot of changes…some good, some bad. I think everyone agrees we need a good, simple, effective EHR system that will integrate seamlessly with other related systems. The problem becomes with getting all the players to work together to create such a system. Every company is worried about profit and securing their section of the market rather than what is in the best interst of the patients, practitioners and payers. The systems has to be something that will work globally to be truly effective. We now have dictation and billing being done off shore to save money, so any system has to work for them. We have surgeries being done remotely via robotic or web instruction so these records have to be able to be accessed globally. We also have the need for other service providers to access and add to the records, such as pharmacies or home health providers so information can be available real time for providers to make the best treatment decisions. With a good system that will serve all those that will interface with it care will improve and after the learning curve, the work load of those using it will decrease. I have always found it funny that while medicine is a field of change, we are some of the slowest to want to adopt change, we do so only while complaining and dragging our feet! I do believe our current EHR options are limited and until we can get cooperation instead of competition between the factions we will not have a strong enough, reliable enough system to see its true capabilities and possibilities. I also believe the best system will probably come about from insiders rather than outsiders trying to get on board with the next great money maker. This will have to happen in the near future, so we as users have to work together to point out the flaws and benefits if we hope to see this technology develop into the useful tool we all need.

]]> By: anonymoushttp://www.kevinmd.com/blog/2009/10/implementing-emr-health-system-harder.html#comment-116450 anonymous Sun, 01 Nov 2009 16:32:52 +0000 http://www.kevinmd.com/blog/?p=40919#comment-116450 emr's are terrible for direct patient care. they may and this is unclear afaik, improve care in the global sense. but they take an enormous amount of the most precious resource-physician time- and convert work other people could do into stuff physician's do.i definitely knew my patient's better when i had to handwrite every medication and past medical problem down myself. when i had to ask about allergies. and when i had time to do those things. Now, i can't concentrate on patients because i get paged incessantly for a million crap things. inpatient or outpatient, can i change it for you? someone somewhere wrote pt smoked. can you enter an order for smoking cessation. pt bmi >x, can you add obesity to list. but i digress. the point was the emr allows other people to scan these charts for all this stuff easily. we should focus on making the emr do what we want as well as what we don't want.whose idea was all this anyway? emr’s are terrible for direct patient care. they may and this is unclear afaik, improve care in the global sense. but they take an enormous amount of the most precious resource-physician time- and convert work other people could do into stuff physician’s do.

i definitely knew my patient’s better when i had to handwrite every medication and past medical problem down myself.
when i had to ask about allergies.
and when i had time to do those things. Now, i can’t concentrate on patients because i get paged incessantly for a million crap things. inpatient or outpatient, can i change it for you? someone somewhere wrote pt smoked. can you enter an order for smoking cessation. pt bmi >x, can you add obesity to list. but i digress. the point was the emr allows other people to scan these charts for all this stuff easily. we should focus on making the emr do what we want as well as what we don’t want.

whose idea was all this anyway?

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